肾病患者增强CT检查对比剂相关急性肾损伤预防的最佳证据总结

Summary of the best evidence for prevention of contrast-associated acute kidney injury after en-hanced CT examination in patients with nephropathy

目的:总结肾病患者增强CT检查对比剂相关急性肾损伤(CA-AKI)预防的相关证据。方法:系统检索国内外相关网站及医学文献数据库中关于肾病患者增强CT检查CA-AKI预防的文献,进行质量评价、证据提取与汇总。检索时限为2013年1月1日至2023年12月1日。结果:共纳入17篇文献,包括指南6篇、专家共识5篇、临床决策2篇、队列研究2篇、证据总结和系统评价各1篇。从17篇文献中提取证据,并经过汇总与分析,共梳理出估算肾小球滤过率阈值与高危人群、筛查、水化预防、药物预防、肾毒性药物的使用、二甲双胍的使用、透析患者注意事项、替代成像策略、碘对比剂的选择、增强CT检查后的注意点等10个证据主题,形成了47条证据。结论:CA-AKI预防的相关证据可为医护人员针对慢性肾病患者在行增强CT检查前早期筛查高风险人群、预防和管理CA-AKI提供较系统的循证依据。

Objective To summarize the relevant evidence for the prevention of contrast⁃associa⁃ted acute kidney injury(CA⁃AKI)after enhanced CT examination in patients with nephropathy.Methods The literature on prevention of CA⁃AKI in patients with nephropathy who underwent enhanced CT examina⁃tion in relevant websites and medical literature databases at home and abroad were systematically searched,the quality of the literature was evaluated,and the relevant evidence was extracted and summarized.The retrieval period was from January 1,2013 to December 1,2023.Results A total of 17 literature was included,including 6 guidelines,5 expert consensuses,2 clinical decisions,2 cohort studies,1 evidence summary and 1 systematic review.Evidence was extracted from these literature.After summary and analysis of these evidence,10 evidence topics were sorted out,including threshold of estimated glomerular filtra⁃tion rate and high⁃risk population,screening,hydration prevention,drug prevention,use of nephrotoxic drugs,use of metformin,precautions for dialysis patients,alternative imaging strategies,choice of iodine contrast agents,and points for attention after enhanced CT examination,forming 47 pieces of evidence.Conclusion The relevant evidence for the prevention of CA⁃AKI can provide a more systematic evidence⁃based basis for medical staffs in screening high⁃risk population and preventing and managing CA⁃AKI in patients with chronic kidney disease before enhanced CT examination.